Significant Incidence of Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty

PURPOSE: To identify and quantify the presence of extra-articular tibia vara that might influence the mechanical axis alignment after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 48 TKAs in 30 osteoarthritic Indian patients were prospectively evaluated. The hip-knee-ankle angle (HKA), joint line convergence angle, and varus angulation at the femur and tibia were measured from the preoperative and postoperative standing hip-to-ankle radiographs. Four different methods were used to measure the varus angulation at the tibia: metaphyseo-diaphyseal angle (MDA), the angle between the anatomical axis and mechanical axis of the tibia, the angle between the proximal third and distal third of tibia and the angle between the proximal half and distal half of tibia. RESULTS: Extra-articular tibia vara quantified using MDA had the most positive correlation with HKA. Receiver operating characteristic plotting showed that MDA of >4degrees predicts abnormal postoperative HKA. Twenty-eight out of 48 knees had MDA of >4degrees, and 78.6% of these had postoperative HKA under-correction and 21.4% had less than ideal tibial component position. CONCLUSIONS: A significant inherent extra-articular varus angulation best measured using MDA exists in the proximal tibia in osteoarthritic Indian patients undergoing TKA. MDA of >4degrees is associated with abnormal postoperative HKA. Computer navigation may be useful for achieving ideal correction in such cases.

Proposed Methods for Real-Time Measurement of Posterior Condylar Angle during TKA

PURPOSE: Conventional instruments are known to result in high numbers of outliers in restoring femoral component rotation primarily due to fixed degree of external rotation resection relative to the posterior condylar line (PCL). Outliers can be reduced by determining the patient specific posterior condylar angle (PCA) preoperatively or intraoperatively. There is a paucity of methods that can be used during surgery for determining the PCA. We propose two simple, real-time methods to determine the PCA and hence to measure the axial anatomical variation during surgery. MATERIALS AND METHODS: The study was conducted using axial computed tomography (CT) scans of the knees of 26 patients. The commercial software K-PACS and our proposed two methods (trigonometric and protractor) were used to measure the angle between the transepicondylar axis and PCL, i.e., PCA. Statistical comparison between the mean angles obtained by K-PACS and our methods were done. RESULTS: The three methods resulted in similar PCAs. The mean PCA measured by the three methods were similar. The mean PCA value measured by the K-PACS, trigonometric method and protractor method was 6.27degrees (range, 0degrees to 12degrees), 6.23degrees (range, 0degrees to 11.11degrees) and 6.31degrees (range, 0degrees to 12degrees), respectively. There were significant correlations between the K-PACS measured PCA and trigonometrically or protractor measured PCA. CONCLUSIONS: Our novel, simple, easily reproducible, real-time and radiation-free PCA measurement methods obviate the need for preoperative CT scan for identification of patient specific PCA.

Prevalence, severity, and risk factors of symptomatic gastroesophageal reflux disease among employees of a large hospital in Northern India.

Background and aims Gastroesophageal reflux disease (GERD) is considered to be a common and chronic gastrointestinal disorder. The prevalence of GERD is believed to be less in Asia than in Western countries. Population-based data on GERD are lacking from India. The present study aimed at determining the prevalence of GERD symptoms in an adult Indian community and the potential risk factors associated with GERD. Methods The study population consisted of all the employees of All India Institute of Medical Sciences, New Delhi. An interview-based observational study was done on the basis of an earlier validated questionnaire. The subjects were asked about the frequency and severity of heartburn and/or regurgitation experienced by them in the previous year. These symptoms were then scored from 0 to 18. Subjects with a score of at least 4 were considered to have symptomatic GERD. Association of GERD with factors like age, sex, BMI, Kuppuswamy social class index, smoking, alcohol, NSAID use, and comorbid illness was analyzed. Results A total of 4079 employees were interviewed in person on a 29-item questionnaire from June 2003 to January 2005. Of the 4039 eligible subjects, 653 (16.2%) had GERD; 3.6% had heartburn on daily basis and 5.9% on a weekly basis. The corresponding prevalences for regurgitation were 3.3% and 5.0%, respectively. One hundred and eight of 4039 (2.7%) had severe GERD symptoms. Higher BMI (OR=1.90, 95% CI: 1.4–2.6 for BMI ≥25), current smoking (OR=1.48, 95% CI: 1.19–1.83), asthma (OR=3.13, CI: 2.06–4.76) and hypertension (OR=1.71, 95% CI: 1.16–2.50) were associated with the presence of GERD symptoms. Conclusions Prevalence of GERD in an urban adult population from northern India is 16.2% which is similar to other industrialized countries. Higher body mass index, current smoking, and presence of asthma or hypertension predisposes to GERD in our population.